Terms Related to Processing Medical Bills The following are some terms that are related to processing medical bills:

Beneficiary: In relation to processing medical bills, a beneficiary is someone who is covered by a health insurance policy.

Capitation: Capitation is how much policyholders or their employers are required to pay a health insurance agency. This amount is not based on how often the policy is actually used.

Coinsurance: Coinsurance, often referred to as co-payment, is how much a person needs to pay toward medical bills before the health insurance agency will help cover expenses. Coinsurance is commonly represented by a certain percentage. In some cases there is a flat fee required whenever a beneficiary visits a hospital or medical office, though this amount is usually small.

Exclusion: Exclusions are parts of health insurance policies that outline specific items that are not covered by the plan. This may include certain things like plastic surgery that is deemed medically unnecessary.

Guaranteed Issue: A guaranteed issue insurance policy is one that grants coverage to an individual without regard to their income, age, current health, and similar factors. A guaranteed issue policy will continue to remain in effect so long as the policyholders continue to pay for it.

Medical Underwriting: Medical underwriting refers to health insurance companies determining an individual’s eligibility, or ineligibility, for coverage. This is also how the cost of the policy is determined.

Primary Care Provider: A primary care provider, or PCP, is the main healthcare physician that an individual visits. PCPs are usually general practitioners, not specialists.

Reasonable and Customary Fees: Reasonable and customary fees are essentially the average cost for medical services in a certain location. The amount that an insurance policy will pay for office visits, hospital care, and other medical services will be based on this amount.

Rider: A rider is a change of an insurance policy that typically alters included benefits or payment amounts.

Stop-loss: Stop-loss occurs when the policyholder has covered all deductions, co-payments, and other fees and the insurance company is paying for the entirety of all claims that are included on the policy.

American Medical Billing AssociationMake sure you choose only the most reputable provider of medical bill processing services for your business or practice. Keep your patients happy and grow your businesses with help from our members.

If you work for a hospital or doctors office that does not have a medical bill processing department, then you might want to outsource those services to professional processors that have years of experience. You can find several medical bill processing companies in the directory and online, but you need to know what questions to ask them to help you choose the one that is best for you. Ask the processors how long they have been in business. If the processors have several years of experience in the health care industry, then they should be familiar with industry regulations. They should have a system that lets them charge individuals and private health care insurance companies for surgery, hospital stays, medicine, and procedures. Ask the company if they have equipment that will let them input the health care expenses into their system and print up the bills in a timely manner so that your business can get payment for the medical procedures that you provide your patients. While you need to be sure that you are getting processors that can give you all of the medical bill processing services that you need, you also want to pick someone with a good price. Ask the companies to give you a written price quote. When you have several quotes, you can compare them to determine which ones will help you save the most money. After all, if you have to pay a lot to outsource your billing, then you might have to charge your patients more money, which will make your company less competitive.